Hamilton family grateful for one-of-a-kind doctor in West Michigan

Katy Batdorff | The Grand Rapids PressDan and Judy Key hug their son, Brian, 18, who recently overcame a pituitary tumor, thanks to the discovery of a neuro-ophthalmologist.

GRAND RAPIDS -- Even before examining Brian Key's eyes, Dr. Christopher Glisson was sure the problem was not in his eyes, but in his brain.

A tumor on the pituitary gland likely was pressing on the optic nerves, he believed, narrowing the high school senior's peripheral vision. Other doctors suspected a tumor, but it was Glisson's specialized training as a neuro-ophthalmologist that helped him find it.

Yet he and his kind are an endangered species in the medical field, members of a sub-specialty that is losing practitioners because of the relatively low pay. They are victims of a health insurance system that rewards doctors who perform a lot of procedures and penalizes those who spend much time with their patients.

FOR EXAMPLE

A 2008 survey found wide disparities in average annual compensation for different kinds of medical specialists:

"You can certainly make a lot more money," Glisson said. "To me, that's not where I thought my talents lie."

As President Barack Obama is calling for health care reform, many critics say one thing that must change is the skewed payment system that encourages doctors to go into more lucrative specialties. Because of the relatively lower pay, there is a shortage of primary-care doctors and other specialists who can help patients avoid serious -- and costly -- medical problems.

Glisson sees fewer patients in an average day than most doctors, but he spends an hour or more with each.

He is the only neuro-ophthalmologist in West Michigan and among only eight in the state. Of the 400 neuro-ophthalmologists in the country, 140 will reach retirement age in the next decade, according to the North American Neuro-Ophthalmology Society, and only 20 medical residents have chosen that specialty in the past four years.

Hollyn Johnson | The Grand Rapids PressDr. Christopher Glisson, in one of his examination rooms last week at Saint Mary's Hauenstein Center.

The average neuro-ophthalmologist makes $120,000-$150,000 a year, according to an online forum for student doctors, well below the earning potential for other specialists.

Glisson spent an hour and a half talking with Brian Key and examining his eyes to rule out a problem in the eyes themselves. Key, 18, began noticing the field of vision in his left eye was narrowing last fall.

"I was thinking maybe my prescription needed to be changed," said Key, who wears contact lenses. "I just kind of kept going on and didn't think about it."

Sitting in the kitchen of his Hamilton-area home one Sunday, he mentioned to his mother, Judy Key, that he couldn't see the minister in church earlier that day. She took him to his eye doctor in Grandville, who confirmed the loss of peripheral vision but could find nothing wrong with Brian's eyes. He sent him to a glaucoma specialist, then to a retina specialist.

"We kept going from doctor to doctor," Judy Key said. By November, the vision loss had spread to his right eye. "That was scary," she said. "We knew whatever it was, it was bad, and we were running out of time."

Finally their family physician suggested Brian meet with a new doctor in town, a neuro-ophthalmologist. The morning of Nov. 5, Brian sat in Glisson's office at Saint Mary's Health Care describing his symptoms.

"Right away when he told me that, I thought there was some sort of mass pressing on the optic chiasm," the intersection of the optic nerves, Glisson said. "Brian's was a classic example."

An MRI confirmed a golf ball size tumor had formed on his pituitary gland at the front of his brain and was pressing against his optic nerves. Going blind would be serious enough, but the tumor was interfering with the pituitary's function as the body's master gland regulating hormones secreted by the other glands. Of more immediate concern was evidence the tumor was bleeding, and that could be fatal.

The following morning Dr. Jurgen Luders, a neurosurgeon, removed the tumor, a pituitary adenoma, by operating through Brian's nose. As soon as he awoke from the surgery, the improvement was striking. "I can see," Brian said. He takes a pill twice a week to keep the tumor from returning.

For Glisson, it was another example of how a patient's eyes are windows through which he can see a variety of ailments that have little to do with the eyes. Diseases throughout the body, including diabetes, high blood pressure and multiple sclerosis, as well as brain tumors, often reveal themselves in a patient's eyes, he said.

"We don't see with our eyes," Glisson said. "We see with our brain. Fifty percent of our brain is responsible in some way for vision. The eyes are basically cameras that feed visual information to the brain. In my biased view, all other organs exist to support the brain."

Some patients are unaware they have a disease until it begins to affect their vision, he said, such as the young woman who came to his office recently complaining of headaches and extreme vision loss. In five days, she had gone from normal vision to legal blindness. Glisson determined a buildup of spinal fluid was causing pressure on the optic nerves. With medication, the pressure was relieved, and her vision returned.

"That's the one thing about vision: It tends to get people to the doctor," Glisson said. "Sometimes we're the gateway to getting people the medical care they need."

Despite the many years of education -- four years in college, four more in medical school, four in a neurology residency program and a year in a neuro-ophthalmology fellowship -- "often we don't generate enough revenue to support our overhead," Glisson said.

That's why most neuro-ophthalmologists are employed by large academic institutions. Glisson, 35, is on the faculty at Michigan State University's College of Human Medicine and spends 80 percent of his time seeing patients at Saint Mary's new Hauenstein Center.

When he came to Grand Rapids a year and a half ago, he spent a lot time not only meeting with other doctors but explaining what he does. Grand Rapids could use another neuro-ophthalmologist, he said -- not that there are that many available.

Judy and Dan Key never had heard of a neuro-ophthalmologist until their son needed one, and they were surprised to find him in Grand Rapids.

"We were pretty much thinking he would have to go to Ann Arbor or some big city," Dan Key said.